The Journal of hand surgery, European volume
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J Hand Surg Eur Vol · Oct 2006
Review Randomized Controlled Trial Meta AnalysisA comparison of traditional digital blocks and single subcutaneous palmar injection blocks at the base of the finger and a meta-analysis of the digital block trials.
A randomised, double-blinded, controlled trial was performed to compare traditional digital blocks with single subcutaneous palmar injection blocks at the base of the finger. A search for randomised controlled trials of digital blocks through MEDLINE, EMBASE, Cochrane Controlled Trials Register and CBM was conducted and a meta-analysis including the current trial was performed. ⋯ The meta-analysis suggests that traditional digital blocks and single subcutaneous palmar injection blocks are similar with regard to injection pain and are less painful than the transthecal digital block. The palmar techniques, including single subcutaneous palmar block and transthecal block, carry a risk of not anaesthetising the dorsum of the digit adequately, particularly the dorsum of the thumb and the proximal phalanx of the fingers.
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The author investigated the pattern of injury and outcome of management in 11 adults with phalangeal neck fractures. The mean age was 40 years. The fracture occurred at the neck of the proximal phalanx of the thumb in seven cases and at the neck of the middle phalanx of the fingers in the remaining four cases. ⋯ The final outcome of Type II fractures was considered good in eight patients and fair in one patient. One patient had a Type III fracture (the displaced distal fragment was rotated 180 degrees with no bone-to-bone contact with the proximal fragment). The fracture required open reduction and K-wire fixation and the final result was poor.